The association between atherogenic index of plasma and risk of preeclampsia: a prospective cohort study.

BackgroundHyperuricemia is a major risk factor for cardiovascular disease. This study aimed to investigate the relationship between the atherogenic index of plasma (AIP) and serum uric acid (SUA) levels, as well as the risk of hyperuricemia.MethodsUtilizing data from the National Health and Nutrition Examination Survey (NHANES), we conducted a cross-sectional study involving 9,439 participants aged 18 years and above with complete triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) data. AIP was calculated as the logarithm of the ratio of TG to HDL-C. Weighted linear regression, weighted logistic regression, subgroup analysis, generalized additive model, restricted cubic spline and two-part linear and logistic regression were utilized to examine the relationships between AIP and SUA levels and hyperuricemia risk.ResultsWe identified a non-linear and L-shaped relationship between AIP and both SUA levels and hyperuricemia prevalence, with significant increasing observed up to a saturation point (0.588 for uric acid levels and 0.573 for hyperuricemia prevalence). Below these thresholds, the odds ratios (OR) for increased SUA and hyperuricemia were 0.854 (95% confidence interval [CI]: 0.762, 0.946) and 4.4 (95% CI: 3.528, 5.488), respectively (P<0.001). Beyond these points, the associations were not statistically significant.ConclusionOur findings suggest that AIP is significantly and non-linear associated with SUA levels and hyperuricemia risk, with a saturation effect observed beyond specific thresholds. These insights could inform clinical strategies for managing cardiovascular and metabolic risks associated with elevated AIP. Further longitudinal studies are warranted to confirm these associations and elucidate the underlying mechanisms.

Relationship Between Uric Acid, Proteinuria, and Atherogenic Index of Plasma in Renal Transplant Patients

Objective To study the relationship between atherogenic index of plasma (AIP)and renal impairment in male patients with gout. Methods A retrospective analysis of 821 male subjects was conducted to measure the relevant biochemical indicators and to calculate the AIP, endogenous creatinine-clearance rate (Ccr), and estimated glomerular filtration rate (eGFR). EpiData 3.1 software was used for data entry, SPSS21.0 was used for statistical analysis, and GraphPad Prism 6.0 software was used for charts. Results Compared with control group, AIP, serum uric acid, triglyceride in gout group were significantly higher (all P 0.05), while Ccr and serum uric acid levels gradually increased (P<0.05). Logistic regression analysis after adjusting for various confounding factors showed that AIP, triglyceride, and serum uric acid were risk factors for renal function damage in patients with gout (P<0.05), the relevant risk were 7.030, 1.291, 1.004 respectively. After adjusting confounding factors, the associations between triglyceride, serum uric acid and renal function injury risk changed little, while AIP showed more evident, the OR value increased from 2.629 to 6.265 and 7.030. Conclusions (1)AIP is closely related to the renal function damage of patients with gout. After adjusting various confounding factors, AIP can better reflect the renal function damage than other indicators, which is of great significance to predict the renal function damage of patients with gout. (2)That patients with gout with high uric acid level may suffer from renal atherosclerosis and have a higher risk of renal impairment. (3)Dynamic observation of AIP in gout patients is helpful for early identification of the risk of renal failure in such patients. Key words: Gout; Renal damage; Atherogenic index of plasma; Confounding factors

To investigate the relationship between the duration of moderate-intensity aerobic exercise and the atherogenic index of plasma(AIP) in middle-aged men, in order to provide evidence to formulate strategies for the prevention of cardiovascular diseases. Methods A cross-sectional study was conducted in 27, 827 middle-aged Chinese men who underwent health examinations at our hospital between January, 2014 and June, 2015. The correlation between the duration of moderate-intensity aerobic exercise and AIP was analyzed. Results The mean AIP levels were(0.1166±0.3448), (0.1167±0.3264), and(0.0765±0.3287) in the <1 min/week group, 1-89 min/week group, and ≥90 min/week group, respectively. AIP levels were higher in the <1 min/W group and 1-89min/W group than in the ≥90 min/W group(both P<0.05). Multiple linear regression analysis showed that physical activity significantly reduced AIP after adjustment for age, body mass index, diastolic blood pressure, fasting blood glucose and uric acid levels. The percentage of the population at high risk for atherosclerosis(AIP ≥ 0.21) was significantly lower in the ≥90 min/W group than in the<1 min/W group and 1-89 min/W group(both P<0.05), while no significant difference was found between the <1min/W group and 1-89min/W group. Conclusions The duration of aerobic exercise has a close relationship with AIP. Moderate-intensity aerobic exercise at a weekly duration of 90 min or longer offers cardiovascular health benefits and reduces the risk for atherosclerosis. Key words: Exercise; Atherosclerosis

To investigate the risk factors of atherogenic index of plasma (AIP) in elderly male hypertensive patients. According to the cutoff point of AIP at 0.06, 384 elderly male hypertensive patients with AIP≥0.06 were enrolled as atherogenic phenotype group(A group) while 352 age and blood pressure matched male hypertensive patients with AIP<0.06 were enrolled as non-atherogenic phenotype group (NA group). Clinical biochemistry data and physical examination indexes were compared between the two groups. Parametric test showed that uric acid (UA), fasting blood-glucose (FBG), body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) in group A were higher than those in group NA (all P<0.01). Binary logistic regression analysis revealed that WC, UA, FBG were independent risk factors of AIP (all P<0.01). These results indicate that elderly male hypertensive patients should regularly monitor and control their waist circumference, uric acid and fasting blood glucose levels to better control AIP and the risk of developing atherosclerosis. Before conducting relevant blood and imaging examinations, waist circumference can serve as a preliminary screening index for atherosclerosis in this population, evaluating their AIP level and atherosclerosis risk. Key words: Hypertension; Atherosclerosis; Risk factors

ObjectiveTo investigate the correlation between the atherogenic index of plasma (AIP), body mass index (BMI), and sarcopenia in the older adults in China, and to analyze the predictive ability of AIP and BMI for sarcopenia.MethodsThis study utilized data from the 2011–2015 CHARLS database (China Health and Retirement Longitudinal Study, CHARLS), focusing on participants aged 60 years and older. The cross-sectional analysis included 7,744 samples, with 2,398 in the sarcopenia group and 5,346 in the non-sarcopenia group. In the retrospective cohort study, 1,441 participants without sarcopenia at baseline were selected and followed for the development of sarcopenia. Multivariable logistic regression was employed to analyze the association between AIP, BMI, and sarcopenia risk. A restricted cubic spline regression model was used to evaluate the dose-response association, and ROC curve analysis was performed to assess the predictive ability of individual and combined indicators (AIP and BMI). Additionally, subgroup analysis was conducted to explore the association between AIP, BMI, and sarcopenia risk across different demographic groups.ResultsThe cross-sectional analysis demonstrated that sarcopenia was significantly associated with various factors, including age, marital status, education level, residence, smoking, BMI, uric acid (UA), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), AIP, as well as hypertension, diabetes, dyslipidemia, and heart disease (p < 0.05). Logistic regression analysis, adjusted for potential confounders, revealed that the low AIP group was significantly associated with an increased risk of sarcopenia (OR = 1.22, 95% CI 1.03–1.44, p = 0.02), while no significant difference was observed in the high AIP group (OR = 0.83, 95% CI 0.69–1.01, p = 0.07). In the retrospective cohort study, the low AIP group showed a positive association with sarcopenia risk (OR = 1.79, 95% CI 1.18–2.72, p = 0.01), and a similar trend was observed in the high AIP group (OR = 1.69, 95% CI 1.03–2.77, p = 0.04). BMI was inversely associated with sarcopenia incidence, consistent with the cross-sectional findings. Both AIP and BMI showed a nonlinear dose-response relationship with sarcopenia risk, with AIP approximating a U-shaped curve and BMI approximating an L-shaped curve. Subgroup analysis indicated that, in the 65–69 age group, low AIP levels were significantly associated with an increased risk of sarcopenia. In participants aged 70 and above, as well as in females, both low and high AIP levels were significantly associated with higher incidence risk. ROC curve analysis showed that the combined use of AIP and BMI for predicting sarcopenia had an Area Under the Curve (AUC) of 0.8913, which was moderately better than the use of AIP (0.6499) or BMI (0.8888) alone.ConclusionThe changes in AIP and BMI are associated with the risk of sarcopenia, and both provide some predictive value for sarcopenia. Taken together, the combined prediction using AIP and BMI appears to be somewhat more effective than using either indicator alone in assessing the risk of sarcopenia.

Association between atherogenic index of plasma and colorectal neoplasms in patients with hypertension.

IntroductionSubclinical hypothyroidism (SH) is defined as an increase in serum-thyroid stimulating hormone (S-TSH) above the normal level with free triiodothyronine (T4) and free thyroxine (T3) within the normal range. It is more common in females. The association between SH and dyslipidemia is unclear. There are many controversial studies regarding the same. This is the single largest study of Atherogenic index of plasma (AIP) in SH among women from our country. Our aim is to study the lipid profile and AIP in SH patients. We will also study the correlation between AIP and S-TSH levels in SH patients.Materials and methodsIt was a retrospective study conducted in a tertiary care center. A total of 97 females with SH were taken as cases and 86 normal females were taken as euthyroid (ET) controls. They were matched for demographic characteristics. T3, T4, S-TSH, total cholesterol, S-triglycerides (S-TG), high-density lipoprotein - cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and AIP were compared between the two groups. Spearman’s correlation between TSH and AIP was studied in the SH group. Mann-Whitney U test was performed.ResultsThe TG, HDL, AIP levels were significantly different between both groups. TG, AIP was higher in the SH group compared to the ET group (p value of TG= 0.01, p value of AIP <0.0001). HDL was lower in the ET group compared to the SH group (p value <0.0001). AIP showed a significant positive correlation with S-TSH levels in the SH group. (r value=0.72, p value=<0.001).ConclusionIt is important to regularly monitor SH patients for dyslipidemia, in order to start early therapy with levothyroxine/statins. Emphasis should be laid on lifestyle changes such as diet and exercise from the time of diagnosis. Community level education and awareness should be encouraged. Also, AIP is a better parameter to assess cardiovascular risk in SH patients than a conventional lipid profile.

BackgroundThe atherogenic index of plasma (AIP), an emerging biomarker of lipid dysregulation, and high-sensitivity C-reactive protein (hs-CRP), an established marker of inflammation, are both implicated in the development of cardiovascular disease (CVD). However, their joint impact on CVD risk and the underlying mediation mechanisms remain unclear.MethodsThis study used data from the China Health and Retirement Longitudinal Study (CHARLS), including 8,763 adults aged ≥45 years with up to 9 years of follow-up. Baseline AIP and hs-CRP levels were measured, and participants were divided into four groups based on the AIP median and hs-CRP threshold (1 mg/L). Multivariable Cox models assessed associations with CVD. Mediation analyses examined direct and indirect effects, including bidirectional mediation. Additive interaction was evaluated using the relative excess risk due to interaction (RERI), and predictive performance was assessed via Receiver Operating Characteristic Curve (ROC) curve analysis.ResultsA total of 1,693 participants developed CVD during the follow-up period. Higher levels of AIP and hs-CRP were independently associated with CVD. Joint analysis showed that, compared with individuals with AIP below the median and hs-CRP <1 mg/L, those with elevated levels of both AIP and hs-CRP had the highest risks of CVD (HR: 1.655; 95% CI: 1.455-1.883), heart disease (HR: 1.402; 95% CI: 1.207-1.628), and stroke (HR: 2.207; 95% CI: 1.771-2.749). These associations remained significant after adjustment for potential confounders, although the effect sizes were attenuated. Notably, the effect of hs-CRP on increased CVD risk was more pronounced among individuals with higher AIP levels. Mediation analysis revealed that hs-CRP mediated 6.6% of the association between AIP and CVD (P=0.042), while AIP mediated 20.3% of the association in the reverse pathway (P=0.008). The RERI between AIP and hs-CRP for CVD was 0.141 (95% CI: -0.102 to 0.384), suggesting a possible positive additive interaction. The ROC analysis indicated that the combined model had better predictive performance for CVD than either marker alone (AUC = 0.590), with the best performance observed in stroke prediction (AUC = 0.615). Subgroup analyses confirmed consistent associations across demographic and clinical subgroups, except in individuals with prediabetes or diabetes.ConclusionsElevated levels of AIP and hs-CRP were independently and jointly associated with an increased risk of cardiovascular disease, particularly stroke. The observed mutual mediation effects and potential additive interaction suggest that lipid metabolism and inflammation may be interconnected in the pathophysiological processes underlying cardiovascular risk. These findings highlight the potential value of incorporating both biomarkers into cardiovascular risk assessment models to enhance early identification and prevention strategies among middle-aged and older adults.

Aims: Among patients who are hospitalized with heart failure (HF), about 50% have readmissions within 6 months. The impact of atherogenic index of plasma (AIP) and low-density lipoprotein cholesterol (LDL-C) on HF readmission risk is unclear. Our study aims to determine if there is an association between AIP, LDL-C and readmission rate for HF. Methods: We used a public dataset of patients hospitalized with a prior or new diagnosis of HF in Zigong Fourth People’s Hospital in China between 2016 to 2019 (https://doi.org/10.13026/5m60-vs44). AIP was categorized into &lt;0.11 (normal risk), 0.11-0.21 (intermediate risk), and &gt;0.21 (high risk). The association between AIP and 6-month readmission rate was explored through a Cox proportional hazard analysis with a crude model, one adjusted for age, gender, and BMI (Model 1), and one adjusted for additional variables such as type of HF, guideline-directed medical therapy, New York Heart Association cardiac function classification (fully adjusted model). The association between LDL- C tertile (≤1.46, 1.46&lt;LDL-C≤2.1, &gt;2.1 mmol/L) and readmission rate was also analyzed with the same adjustments. Competing risk analysis for mortality was done using the Fine-Gray model. Results: A total of 1805 patients were included. There was no significant association between AIP level and readmission rate in the crude model (HR 1.03, 95% CI 0.93-1.14), Model 1 (HR 1.05, 95% CI 0.95-1.17), fully adjusted model (HR 1.03, 95% CI 0.95-1.18), and the Fine-Gray model (HR 0.99, 95% CI 0.94-1.05). In contrast, the higher LDL-C tertile was associated with decreased readmission risk in the crude model (HR 0.87, 95% CI 0.79-0.96) and Model 1 (HR 0.89, 95% CI 0.80-0.97). This association was no longer statistically significant in the fully adjusted (HR 0.93, 95% CI 0.84-1.03) and Fine-Gray model (HR 1.02, 95% CI 0.97-1.08). Conclusion: In this Chinese cohort of hospitalized HF patients, we found no significant association between AIP levels and 6-month readmission rate, even after extensive clinical covariate adjustment and accounting for competing mortality risk. Lower LDL-C level showed a modest trend toward reduced readmission in unadjusted models but this association was not sustained after full adjustment. These findings suggest that AIP and LDL-C may have limited utility as independent predictors of 6-month HF readmission rates. Future research is warranted to evaluate the role of AIP and LDL-C level in long-term HF outcomes.

To examine the correlation between Atherogenic Index of Plasma (AIP) levels and the progression of non-target lesion vascular disease following the deployment of Drug-eluting Stents (DES). We retrospectively enrolled patients who had undergone successful treatment for CAD with DES and subsequently underwent a coronary angiography follow-up at the Cardiology Department of Tianjin Third Central Hospital from January 2017 to July 2022. The annual change in Gensini Score (GS) was calculated according to two angiographic evaluations in order to assess the progression of non-target lesion vascular disease; a change greater than 1 indicated progression, while a change of 1 or less indicated stability. AIP was calculated according to serum lipid parameters. Multivariate Logistic regression model was used to evaluate the relationship between AIP level and progression of non-target coronary artery lesions. The ROC curve analysis was performed to evaluate the diagnostic value of AIP for coronary artery non-target lesion vascular disease progression. Out of the 344 patients who were monitored over a median duration of 1.2 years, 113 exhibited progression of non-target lesion vascular disease. Initially, baseline AIP levels were notably higher in the progression group compared to the non-progression group (0.30 [0.14, 0.43] vs. 0.11 [-0.06, 0.31]), and this difference remained significant during the follow-up period (0.19 [0.06, 0.34] vs. 0.11 [-0.06, 0.22]). Multivariate logistic regression revealed that AIP is an independent predictor for the progression of non-target lesion vascular disease following DES treatment. Individuals in the highest tertile of AIP faced a considerably elevated risk compared to those in the lowest tertile (OR = 4.88, 95% CI: 2.12-11.21, P < 0.001). Moreover, utilizing receiver operating characteristic curve analysis, a 0.15 AIP level cut-off was determined for diagnosing disease progression, with a sensitivity of 73.5% and specificity of 56.7%, and an area under the curve of 0.672 (95% CI: 0.613-0.731, P < 0.01). AIP significantly correlates with the progression of non-target lesion vascular disease among patients with coronary artery disease who have undergone DES treatment, establishing itself as an independent risk factor in addition to conventional predictors.

Background: The atherogenic index of plasma (AIP) is the base-10 logarithmic conversion of the triglyceride to high-density lipoprotein cholesterol ratio [AIP = log10 (triglyceride/HDL cholesterol)]. Some studies have found a link between low serum vitamin D levels, AIP, and fatty liver. This study was conducted to evaluate the relationship between AIP levels, fatty liver, and vitamin D levels in obese adolescents aged 10–17 years. Methods: This study included 136 adolescents, including 83 obese and 53 healthy controls, in the age range of 10–17 years. Thirty-nine of the obese adolescents had fatty livers. Those with ultrasonography grades 2 or 3 of fat were in the fatty liver group. The AIP value was calculated as the logarithmic conversion of the ratio (triglyceride/HDL cholesterol) at the base of 10. Vitamin D and other laboratory tests were analyzed biochemically. Statistical evaluations were made with the SPSS program. Results: The AIP, body mass index (BMI), homeostatic model assessment for insulin resistance (HOMA-IR), and insulin averages of obese adolescents with fatty liver were significantly higher than those of obese adolescents without fatty liver and the healthy control group (p < 0.05). Again, the mean AIP of obese patients without fatty liver was pointedly higher than that of the healthy control group (p < 0.05). There was a positive, moderate relationship between AIP and BMI, AIP and HOMA-IR, and AIP and insulin levels (p < 0.05), whereas there was a negative, moderate (37.3%) relationship between AIP and vitamin D (p = 0.019). Conclusion: AIP levels were higher in obese adolescents, and this increase was higher in obese adolescents with fatty liver in this study. Moreover, we detected a negative correlation between AIP and vitamin D levels and a positive correlation with BMI, insulin resistance, and insulin levels. Based on our data, we concluded that AIP can be a useful predictor of fatty liver in obese adolescents.

BackgroundNon-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are common chronic liver diseases worldwide, both of which are closely associated with an increased risk of cardiovascular disease (CVD). Atherogenic index of plasma (AIP), as a biomarker of dyslipidemia, may predict CVD risk and mortality in these patients, but its specific role in patients with NAFLD and MASLD has not been studied in detail. This study adopted a cohort design, using data from the National Health and Nutrition Examination Survey (NHANES, 1988–1994) database, which was conducted by the Centers for Disease Control and Prevention. A total of 12,929 adult participants were analyzed. After participants were grouped according to AIP quartiles, the relationship between AIP levels and CVD risk was explored using multivariate logistic regression models and restricted cubic splines. The relationship between AIP levels and all-cause and CVD mortality was analyzed using multivariate Cox regression models.ResultsParticipants with the higher AIP quartiles showed high rates of CVD among participants with NAFLD (Quartile 1: 7.57%; Quartile 2: 10.00%; Quartile 3: 11.63%; Quartile 4: 15.08%). Participants with the higher AIP quartiles showed high rates of CVD among participants with MASLD (Quartile 1: 9.71%; Quartile 2: 11.30%; Quartile 3: 11.14%; Quartile 4: 15.00%). The findings suggested a linear association between the AIP index and the risk of CVD in participants with NAFLD or MASLD. AIP was significantly associated with CVD in the highest quartile of NAFLD or MASLD patients, and the adjusted hazard ratio indicated that high AIP levels were associated with high risk of CVD among participants with NAFLD (HR: 1.77, 95% CI: 1.24, 2.52) and MASLD (HR 1.76, 95% CI: 1.04, 2.98). In addition, higher AIP levels were also associated with increased all-cause mortality and CVD mortality among participants with NAFLD or MASLD.ConclusionThis study showed that AIP is an effective tool for predicting CVD risk and mortality in patients with NAFLD and MASLD. Regular monitoring of AIP levels can help identify high-risk patients early and provide clinical risk assessment before intervention, thereby improving patient management and prognosis. Future studies need to further explore the role of AIP in different ethnic and economic conditions to optimize cardiovascular disease prevention and treatment strategies.

Background and Objectives: Numerous studies have explored the biomarker atherogenic index of plasma (AIP) in relation to metabolic syndrome (MetS), showing its potential utility in assessing this condition. However, the existing evidence remains inconsistent and inconclusive. Therefore, this study aimed to evaluate the association between AIP and MetS and assess its predictive accuracy. Materials and Methods: A comprehensive search of PubMed, EMBASE, and Scopus was conducted using a predefined search strategy to identify relevant studies. Eligible studies diagnosed MetS based on the International Diabetes Federation criteria. The primary outcomes were the mean difference (MD) in AIP between MetS patients and healthy controls, as well as the area under the curve (AUC) for AIP in predicting MetS. Results: Thirteen studies involving 17,689 participants met the inclusion criteria and were included in the systematic review and meta-analysis. AIP levels were significantly higher in MetS patients compared to healthy controls, with an MD of 0.309 (95% CI 0.214, 0.405). In contrast, the difference in AIP levels between type 2 diabetes mellitus (T2DM) patients with MetS and normoglycemic MetS patients was not statistically significant (MD 0.142, 95% CI -0.091, 0.376). The predictive accuracy of AIP for MetS yielded an AUC of 0.864 (95% CI 0.856, 0.871). Conclusions: AIP levels are significantly elevated in MetS patients compared to healthy individuals, supporting AIP's potential role as a biomarker for MetS. However, AIP levels did not differ significantly between T2DM patients with MetS and normoglycemic MetS patients. The predictive accuracy of AIP for MetS is acceptable, indicating that AIP may serve as a useful tool in MetS diagnosis. Further research is warranted to clarify its diagnostic and prognostic significance in clinical settings.

BackgroundPatients without any standard modifiable cardiovascular risk factors (SMuRF-less) who develop acute coronary syndrome (ACS), tend to have poor outcomes. However, the prognostic value of atherogenic index of plasma (AIP) in these patients is unclear. Therefore, we investigated the association between AIP and adverse outcomes in SMuRF-less patients with ACS.MethodsThis study retrospectively enrolled 722 SMuRF-less patients with ACS receiving percutaneous coronary intervention (PCI) at Beijing Anzhen Hospital from March 2017 to March 2018. Three patient-groups were formed using AIP tertiles. The primary outcome, major adverse cardiovascular and cerebrovascular events (MACCE), was a composite of all-cause mortality, non-fatal myocardial infarction (MI), unplanned revascularization, and non-fatal ischemic stroke. Association between AIP levels and MACCE risk was examined using restricted cubic spline (RCS) analysis. Prognostic value of AIP levels for MACCE was assessed using multivariable Cox regression models and machine learning approaches.ResultsDuring follow-up of the 722 patients (median age, 60 years [interquartile range, 53–67]; female, 29.8%; median follow-up duration, 59 months), 168 (23.3%) developed MACCE. The RCS results showed linear association of progressively increasing MACCE risk with increasing AIP levels. In multivariable Cox regression analysis, significantly higher MACCE risk occurred with the highest AIP tertile than with the lowest (hazard ratio [HR] 2.03, 95% confidence interval [CI]: 1.34–3.08; P < 0.001). Elevated AIP level was associated with higher risks of all-cause death (HR: 3.49, 95% CI: 1.09–11.23; P = 0.036); non-fatal MI (HR: 3.02, 95% CI: 1.08–8.48; P = 0.035); and unplanned revascularization (HR: 2.18, 95% CI: 1.34–3.52; P < 0.001). As a continuous variable, higher AIP levels were significantly associated with increased risks of MACCE (HR: 2.95, 95% CI: 1.74–4.98; P < 0.001), all-cause mortality (HR: 6.80, 95% CI: 1.85–24.96; P = 0.003), non-fatal myocardial infarction (HR: 3.58, 95% CI: 1.08–11.86; P = 0.037), and unplanned revascularization (HR: 2.84, 95% CI: 1.55–5.19; P < 0.001). Machine-learning models incorporating AIP levels improved outcome prediction. At 48 months, the gradient boosting machine model achieved the highest AUC (0.796; 95% CI: 0.703–0.889), while complementary assessments showed that the random survival forest model provided the greatest net clinical benefit and demonstrated excellent calibration.ConclusionAmong SMuRF-less patients with ACS undergoing PCI, AIP level was identified as an independent predictor of clinical prognosis.